Con: Should Varicocele Be Repaired Before ART?

Abstract

Varicoceles are present in 15–20% of post-pubertal men with a 2–3 times increased likelihood of diagnosis in those presenting for infertility evaluation. However, not all men with varicoceles suffer from subfertility. There is no diagnostic measure in current clinical practice that may predict which individuals will have a negative sequela or which will see improved fertility potential following repair. Despite decades of published literature, the heterogeneous study populations and methodological parameters, as well as a broad range of outcome measures, there continues to be a lack of consensus on the management of varicoceles in the infertile couple. The clinical debate that surrounds the repair of a clinically palpable varicocele prior to assisted reproduction focuses on two patient cohorts: the non-azoospermic male and the azoospermic male.

In reproductive care, management is unique in that it relies upon management of the couple and a very specific outcome: delivery of a healthy child. Interpretation of the published literature must focus not only on the findings but also on the methods, assessing the applicability of a given study to broad clinical practice. For better or worse, age, female factors, and clinical timeline often play an integral part in the reproductive management of a couple, and, therefore, broad application of management studies ought to be applied with such considerations in mind.